Challenges in robotic assisted pyeloplasty in a partial duplex system

Abstract

Introduction: Pelvic-ureteric junction obstruction (PUJO) in a duplex system is an nusual entity that commonly involves the lower moiety [1–3]. The surgical management in such cases may be very challenging due to anatomical issues. We report our experience with robot assisted pyeloplasty in a case of partial duplex system with lower moiety PUJO. Materials and methods: A 59-year old woman presented with a recurrent right flank pain of a 3 years duration. Ultrasonography showed hydronephrosis of the right kidney and CT scan revealed a right partial duplex system. A UPJO was confirmed as having originated from the extensive dilated lower moiety of the duplex system. MAG-3 renogram showed a 53% kidney function in the right kidney.We planned a robot assisted laparoscopic pyeloplasty previous to a Contour stent positioning according with the “window technique” [4,5]. Results: Total operative time was 167 minutes with a total blood loss of about 20 cc. The post-operative course was uncomplicated and the patient was discharged on postoperative day four. The double J stent was removed six weeks after surgery. The post-operative MAG-3 renogram performed at 4-month from surgery did not show significant modification in terms of kidney function. Conclusions: Robotic-assisted pyeloplasty for lower moiety UPJ obstruction in a partial duplex system is feasible, safe and effective. The experience of the surgical equipe and a good preoperative plan are the key to success.

Keywords

• PUJO
• Pyeloplasty
• Robotic pyeloplasty
• Duplex kidney
• Pelvic-ureteric junction obstruction